REQUEST CCPG FORM Please complete this form if you are interested in CCPG being a part of your event and hosting a resource table full of information and giveaways or helping to facilitate one of our many training offerings featuring topics about problem gambling. Name Title Email Phone Organization Name of Event Date of Event Event Start Time Event Location Type of Event Training/Workshop/Presentation Resource Table Other Training/Workshop/Presentation Information: Topic/ Audience/ Duration/ Setting/ Tech Equipment Needed Resource Tabling Information: Audience/ Duration/ Setting/ Outdoor or Indoor Any Additional Information Send